Jospt 2012 42 1 A114 PDF

Combined Sections Meeting
Sports Physical Therapy Section

Abstracts: Poster Presentations
SPO1100-SPO1125
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SPO designates a Sports Section poster presentation.
Copyright © 2012 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
SPO1100 CONCLUSIONS: ITBS runners had a lower postexertion ROF when exert-
HIP MUSCLE ACTIVITY IN RUNNERS WITH ILIOTIBIAL BAND SYNDROME: ed, yet IMF values were also decreased at this time. The ROF measure
THE EFFECT OF EXERTION describes a change in EMG frequency during the isometric contraction
Brown A, Lenhoff M, Hillstrom H, Zifchock B while the IMF provides a single frequency value at the start of the con-
Rehabilitation, Hospital for Special Surgery, New York, NY; Department traction. Decreased postexertion IMF values in the presence of a smaller
of Civil and Mechanical Engineering, United States Military Academy, postexertion ROF suggest a frequency shift occurred during the run to
West Point, NY exertion and was therefore not seen during isometric testing. IMF find-
PURPOSE/HYPOTHESIS: During the loading phase of running gait, hip ab- ings suggest the GM of ITBS runners is less resistant to fatigue than
ductor activity is required for shock absorption. Hip abductor strength healthy runners. Exertion did not affect strength or onset activation tim-
deficits are thought to contribute to iliotibial band syndrome (ITBS). A ing differently between groups. All runners demonstrated decreased GM
unique characteristic of ITBS is the relative absence of symptoms during strength following the run to exertion.
Journal of Orthopaedic & Sports Physical Therapy®
the early stages of running, which suggests that fatigue-related changes CLINICAL RELEVANCE: Decreased GM endurance and fatigue may make
may be a contributing factor. One trait of fatiguing muscle is a shift in the runners more susceptible to ITBS than strength deficits alone. Thera-
EMG power spectrum to lower frequencies. Analysis of the EMG power pists should consider focusing treatment on endurance type exercises.
spectrum is thus a method of examining muscular fatigue. The purpose
of this study was to investigate the effects of exertion on hip muscle func- SPO1101
tion in female runners with ITBS. Hypothesis: There will be a significant ASSESSMENT OF READINESS FOR RETURN TO SPORT IN ELITE ATHLETES
effect of exertion on hip muscle function and onset activation timing. WITH FOOT AND ANKLE PATHOLOGY: UTILIZATION OF 4 CLINICALLY
NUMBER OF SUBJECTS: Twenty uninjured and 12 female runners with ITBS RELEVANT FUNCTIONAL TESTS: A CASE SERIES
were included in this study. Jeronimus A, Thigpen CA, Clanton T
MATERIALS/METHODS: Gluteus medius (GM) isometric rate of fatigue Howard Head Sports Medicine, Vail, CO; The Steadman Clinic, Vail, CO;
(ROF), initial median frequency (IMF) and strength, as well as over- Proaxis, Greenville, SC
ground running GM and tensor fascia latae (TFL) EMG data were BACKGROUND & PURPOSE: Little evidence exists to provide a framework to
collected prior to and following a treadmill run to exertion. Outcome guide postoperative foot and ankle rehabilitation. The purpose of this
variables of interest included GM ROF over a 30-second isometric con- case series is to demonstrate a clinically applicable test battery to evalu-
traction, IMF during the first 2 seconds of the isometric contraction, ate return-to-sport readiness in terms of range of motion, strength, bal-
peak GM torque and terminal swing GM and TFL onset timing. 2-way ance, and agility following foot and ankle injuries.
ANOVAs with post hoc comparisons examined the effects of group and CASE DESCRIPTION: Five elite athletes (mean age, 35  7.05; M = 4, F = 1),
exertion on each variable. Significance was set at P<.05 with a trend op- were tested during their rehabilitation to determine readiness to return
erationally defined as P<.10. to sport including pro basketball, trail running, downhill and freestyle
RESULTS: There was a significant interaction (P = .04) for GM ROF. Fol- skiing. Testing occurred 2 months to 1 year from injury. These patients
lowing the run to exertion, ITBS runners had a decreased ROF (P = .03) represent a wide range of pathology, including: navicular stabilization,
as compared pre-exertion values. Control runners did not exhibit a pre- calcaneal osteotomy, achilles debridement, nonoperative fibular fracture,
to-post change (P = .50). There was a trend towards a significant inter- ORIF fibular fracture with syndesmosis repair, deltoid ligament repair,
action (P = .08) for IMF whereby ITBS runners had smaller postexertion and talar dome microfracture. A comprehensive literature review was
IMF values (P = .01) and healthy runners remained unchanged (P = .99). performed to identify clinically applicable tests that demonstrate accept-
There were no significant interactions for strength (P = .78) and neither able reliability and validity. Functional dorsiflexion (DF) ROM was as-
GM (P = .19) nor TFL onset timing (P = .52). A significant main effect sessed using a loaded DF measurement. Side-to-side anterior reach dif-
of exertion (P = .01) demonstrated postexertion decreases in strength ference of the Y-balance test (Y-diff ) was used as an indicator of balance
across groups. as well as lower extremity injury risk. The vertical jump test was used to
a114 | january 2012 | volume 42 | number 1 | journal of orthopaedic & sports physical therapy
42-01 CSM Sports Posters.indd 114 12/30/11 11:07 PM

compare the lower extremity strength and explosive power. The MAT averaged 1.1.
test was used as a marker of patient’s agility and speed. In order to be CONCLUSIONS: Side and prone bridge endurance measures differed among
cleared for unrestricted return to sport, the Y-diff should be <4 cm, while all 4 groups, indicating the need for use of age-matched normative data.
all other measures should be pain-free and within 90% of the uninvolved However, for pectoral length and IR/ER strength measures, differences
extremity. were only found between the DI swimmers and the other groups. Per-
OUTCOMES: Athlete 1 passed 3/4 tests (DF 80%, Y-diff 4 cm, VJ 90%, haps the greater endurance, longer pectoral length and relative internal
MAT 100%), clearing the athlete to progress along a sport progression rotation strength gain of the collegiate swimmers are optimal for perfor-
while also given mobilizations to address dorsiflexion deficit. Athlete mance at the highest competitive level. Determining if these character-
2 passed 1/4 tests (DF 87%, Y-diff 4 cm, VJ 76%, MAT d/c). Athlete 3 istics are premorbid physical attributes or training adaptations requires
passed 2/4 tests (DF 88%, Y-diff 0 cm, VJ 87%, MAT 96%) and was further study.
cleared for sport progression, in addition to mobilizations to improve DF CLINICAL RELEVANCE: Prior studies demonstrating a high prevalence of
ROM, and a lower extremity program to improve VJ. Athlete 4 passed shoulder pain in competitive swimmers point to a need for screening
2/4 tests, (DF 42%, Y-diff 6 cm, VJ 92%, MAT 100%). Athlete 5 passed and prevention programs. Research has identified pectoral length, shoul-
1/4 tests (DF 50%, Y-diff 5 cm, VJ 88%, MAT 97%). Athletes 2, 4, and 5 der strength, and endurance deficits in those with pain and disability.
were not cleared to progress along a sport progression. Normative data obtained from this study may provide a starting point
DISCUSSION: Two athletes were given clearance to start a sport progression for identification of at risk swimmers or provide target values for shoul-
based on their functional test performance. The 3 athletes that were not der pain prevention programs.
cleared to compete after testing were given clear goals and a redirected
rehabilitation program. Such programs included: manual techniques to SPO1103
improve ROM, exercises for balance, proprioception, strength, and/or BAREFOOT AND MINIMALIST SHOD RUNNING: A SURVEY
agilities to improve absorption and speed with higher impact exercise. OF COMMUNITY RUNNERS
Our experience implementing this battery of tests with athletes suggests Rothschild CE
that it is helpful in determining readiness for return to sport. This bat- Physical Therapy, University of Central Florida, Orlando, FL
tery provides a validated, simple, and functional method to assess ROM, PURPOSE/HYPOTHESIS: Recently there has been a movement promoting
balance/proprioception, strength, and agility in athletes following foot running barefoot and/or in light, “minimalist” shoes. Advocates of bare-
and ankle injuries. foot running believe that returning to a more primitive style of running
may result in fewer running-related injuries and possibly improve per-
SPO1102 formance. Little is known about the type of runner or the practice pat-
NORMATIVE VALUES FOR PHYSICAL MEASURES IN YOUTH THROUGH terns implemented when transitioning to running barefoot or in mini-
COLLEGIATE FEMALE COMPETITIVE SWIMMERS malist shoes. The purpose of this study is to identify the current interest
Tate A, Turner G, Knab S, Harrington SE, Meisel CE level and participation in barefoot or minimalist shod running and to ex-
Department of Physical Therapy, Arcadia University, Glenside, PA; amine runner demographics, motivating factors, utilized resources, per-
Department of Clinical & Applied Movement Sciences, University of North ceived barriers and expectations in runners who add barefoot or mini-
Florida, Jacksonville, FL malist shod running to their training program.
PURPOSE/HYPOTHESIS: Over 300,000 swimmers compete annually in US NUMBER OF SUBJECTS: Seven hundred eighty-five runners in Central
Swimming sanctioned events, and up to 91% of competitive swimmers Florida.

report shoulder pain. Potentially modifiable risk factors have been iden- MATERIALS/METHODS: An electronic survey was developed and dispersed
tified in youth through high school swimmers. Core endurance, strength, to 6082 runners. Frequency analysis, percentages, and descriptive statis-
and flexibility deficits have been found to be more prevalent in swim- tics were used to examine the responses. Spearman’s rho correlation coef-
mers reporting shoulder pain and disability. We sought to obtain similar ficient was calculated for the relationship between respondent’s interest
data in collegiate swimmers and determine if differences exist among the level and each of the following: age, self-perceived running level, average
measures from 4 age groups. This information could then be used to es- weekly mileage, longest race distance completed in the past 6 months,
tablish normative data for screening/prevention programs. and longest race distance planned to complete in the next 6 months. A
NUMBER OF SUBJECTS: Multicenter trial of 188 competitive female swim- chi-square test of independence was calculated for association between
mers from 4 groups: 42 from Division I (DI) colleges, 62 from high interest level and gender and interest level and history of running injury.
schools (HS), 41 aged 8 to 11 and 41 aged 12 to 14 from youth swim teams. RESULTS: Seven hundred eighty-five (13%) runners completed the survey.
MATERIALS/METHODS: Swimmers underwent a physical exam which in- Six hundred thirty (75.7%) indicated they were at least somewhat inter-
cluded: normalized internal rotation (IR)/external rotation (ER) shoul- ested in running barefoot or in minimalist shoes. One hundred seventy-
der strength ratios using a handheld dynamometer, pectoralis minor two (21.9%) of the respondents had previously tried barefoot running
(PM) length at rest and on stretch normalized to clavicular length, and and 239 (30.4%) had previously tried running in minimalist shoes. The
prone and side plank core endurance measures. An ANOVA and Tukey’s primary motivating factor for those who had added barefoot or minimal-
post hoc tests were used to determine differences among the 4 groups. ist shod running (n = 283) to their training was to prevent future inju-
RESULTS: Differences were found among groups for core endurance ry (n = 97, 34.3%). The most commonly utilized resources were advice
(P<.001), pectoral lengths (P<.001), and IR/ER strength ratios (P<.001). from a friend (n = 68, 24.5%) or a book (n = 68, 24.5%). Fear of possi-
Mean core endurance measures for prone plank and dominant side ble injury (n = 424, 54%) was the most prevalent perceived barrier. An
plank were: 17.6 and 14.6 seconds for 8- to 11-year-olds, 30.1 and 22.1 overwhelming 671 (85.5%) indicated they were at least somewhat likely
seconds for 12- to 14-year-olds, 51.5 and 31.8 seconds for HS swimmers, to continue with or to add barefoot or minimalist shod running if pro-
and 87.1 and 56.7 seconds for DI swimmers. Bilateral normalized PM vided sufficient instruction.
lengths were significantly different between the DI swimmers and the CONCLUSIONS: Community runners reported a considerable interest lev-
other groups with the DI swimmers dominant side mean resting and el in running barefoot or in minimalist shoes. Runners who are men, of
stretched lengths being 1.0 and 1.2 respectively, while the other groups younger age, and who consider themselves elite runners are more likely
resting lengths were 0.82 to 0.84 and stretched lengths were 1.1. Simi- to be interested in barefoot or minimalist shod running. Future research
larly, post hoc testing revealed differences in normalized IR/ER strength is indicated to examine the effects of barefoot running on both injury re-
ratios between the DI swimmers who averaged 1.3 while the other groups duction and performance.
journal of orthopaedic & sports physical therapy | volume 42 | number 1 | january 2012 | a115

CLINICAL RELEVANCE: This study provides information on the growing pop- es, between inning warm-up pitches, game pitches, nongame position-
ularity of running barefoot or in minimalist shoes. Therapists and coach- al throws (before game/between innings), game positional throws, and
es can utilize the information discovered in this study to enhance their cool-down pitches. The investigators reported the average number of
understanding of key factors related to barefoot and minimalist shod each of the aforementioned throws and then compared the throw counts
running and to aid in the supervision of a runner seeking to try these to ASMI baseball pitching guidelines
running techniques. SUMMARY OF USE: The investigators found that on average the subjects
threw 174 total throws on game day. The average number of throws
SPO1104 where as follows: pregame warm-up toss 40, pregame warm-up pitch-
Y-BALANCE TEST PERFORMANCE PREDICTS PATIENT FUNCTION es 30, game pitches 60, between inning warm-up pitches 8 per inning
IN INDIVIDUALS FOLLOWING ACL RECONSTRUCTION pitched, nongame positional throws 20 (before game/between innings),
Shanley E, Stanley L, Galloway P, Thigpen CA, Noda H, game positional throws 8, and cool-down pitches 0. The average number
Bailey L, Padua D of innings pitched was 2.
Proaxis Therapy, Greenville, SC; Department of Exercise Science, Univer- IMPORTANCE TO MEMBERS: Many coaches adhere to the ASMI pitch count
sity of South Carolina-Columbia, Columbia, SC; Department of Exercise & and calendar day rest period guidelines for Little League baseball pitch-
Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, NC ers. It is suggested that 10- to 12-year-old Little League pitchers per-
PURPOSE/HYPOTHESIS: Deficits in Y-balance test (YBAL) performance are form no more than 75 to 85 pitches to a batter per day. This study re-
associated with an increased risk of lower extremity injury. Individu- vealed that Little League pitchers throw on average a total of 174 times
als who have undergone an anterior cruciate ligament reconstruction on game day. The subjects in this study did not exceed the suggested
(ACLR) are at increased risk for lower extremity injury, most notably an- ASMI guidelines for pitches thrown to a batter in 1 day, however, when
other ACL injury. Therefore, the purpose of this study was to compare Y- combining pregame warm-up pitches, between inning warm-up pitch-
balance test performance and self-reported patient function in patients es, and game pitches, the subjects in this study performed over 100 of
following ACLR. those throws at or near full effort. The investigators of this study sug-
NUMBER OF SUBJECTS: YBAL reach distances and IKDC were assessed in 21 gest that due to the high total number of throws that guidelines be de-
subjects with a history of ACLR (M = 12, F = 9; mean age, 22  8 years), veloped and implemented regarding the number of pregame warm-up
mean 10  11 months from reconstruction. pitches and total number of throws on game day to further safeguard
MATERIALS/METHODS: The subjects were asked to perform the Y-balance Little League pitchers.
test on both the involved and uninvolved lower extremity for maximum
reach distance. Two trials for maximum reach distance in the anterior SPO1106
(ANT), posterior lateral (PL), and posterior medial (PM) directions was RELATIONSHIP OF OFF-ICE AND ON-ICE HOCKEY PERFORMANCE
recorded. Normalized distances as a percentage of leg length were then MEASURES IN HIGH SCHOOL MALE HOCKEY PLAYERS
averaged and used for analysis. Paired t tests were performed to com- Krause DA, Smith AM, Holmes L, Klebe C, Lee J, Lundquist K,
pare reach distances between the involved and uninvolved extremities Eischen J, Hollman JH
for each direction (α = .05). Pearson correlation coefficients and simple Program in Physical Therapy, College of Medicine, Mayo Clinic,
linear regression were performed for to assess the relationship between Rochester, MN
reach distances and IKDC score. PURPOSE/HYPOTHESIS: Previous ice hockey research has examined the re-
RESULTS: Normalized reach distance was significantly less in the involved lationship of off-ice performance measures with on-ice measures. Few
extremity for all 3 directions (ANTdifference = –5.5%  5.4, P.01; PM- studies have specifically examined skating crossover and turning perfor-
difference = –5.4%  5.8, P.01; PLdifference = –4.6%  6.9; P.01). mance. The purpose of this study was to examine the relationship of off-
There was a significant positive correlation between IKDC score and ice performance measures with on-ice skating performance, including
normalized reach distances of the involved extremity for PM (r = 0.67, forward sprinting, turning, and crossovers. We hypothesized that off-ice
P.01) and PL (r = 0.63, P.01) but not ANT (r = 0.29, P = .27). The fi- sprint speed, explosive power, and balance would be associated with on-
nal regression model revealed that PM predicted IKDC score (R2 = 0.44, ice performance, and that side-to-side differences in off-ice tests would
P = .01) but not PL (R2 = 0.37, P = .49), or ANT (R2 = 0.34, P = .51). be associated with directional on-ice performance.
CONCLUSIONS: The asymmetry in reach distance for all 3 directions was NUMBER OF SUBJECTS: Thirty-eight male high school hockey players (mean
unexpected given the average length of time since surgery. The deficits  SD age, 16.34  1.05 years; body mass, 72.5  8.91 kg; height, 177.94
in Y-balance performance and their relationship to patient function sug-  6.75 cm) with an average of 1.9  1.07 years playing high school hock-
gest the Y-balance test may provide valuable clinical information during ey participated in this study.
the rehabilitation of patients following ACLR. Future research should MATERIALS/METHODS: Off-ice tests included a 40-m sprint, single and dou-
examine these findings in larger samples and across the rehabilitation ble limb vertical jumps, single and double limb horizontal jumps, later-
continuum. al jumps, and Y-balance tests. On-ice tests included a 34.5-m forward
CLINICAL RELEVANCE: Clinicians should consider limb asymmetry as mea- sprint, 2 short-radius turn courses, 1 with only left turns and a second
sured using the Y-balance test in patients following ACLR. with only right turns, and 2 crossover turn courses, 1 with left crossovers
and 1 exclusively right crossovers.
SPO1105 RESULTS: Results indicated no significant difference between right and
DETERMINING THE TOTAL NUMBER OF THROWS 10- TO 12-YEAR-OLD left short radius performance or between right and left crossover per-
LITTLE LEAGUE PITCHERS PERFORM DURING GAME DAY formance even when considering self-reported turning preference. Five
Bixler J, Boothe K, Boyce D, Fogarty M, Foring E off-ice tests correlated with all on-ice skating measures including off-ice
Physical Therapy, Bellarmine University, Louisville, KY sprint time, lateral bound right to left, double limb horizontal hop, Y-bal-
PURPOSE: To determine the actual number of throws a Little League ance right limb posterolateral, and composite right limb balance. Step-
pitcher performs prior, during, and after a game and comparing it to the wise linear regression demonstrated off-ice sprint speed was the most
American Sports Medicine Institute (ASMI) pitching guidelines. predictive variable of on-ice skating performance. Off-ice sprint speed
DESCRIPTION: The investigators of this study followed fourteen 10- to accounted for a total of 65.4% of the variance in forward skate time per-
12-year-old Little League pitchers over the course of a season and count- formance, 30.8% of right crossover performance, and 36.2% of left cross-
ed the number of pregame warm-up throws, pregame warm-up pitch- over performance.

CONCLUSIONS: The results support the inclusion of power, balance, and Sam Houston, TX; University of Evansville, Evansville, IN;
speed drills as components of off-ice training for ice hockey. Off-ice Duke University, Durham, NC
sprint speed can be used to predict on-ice sprint speed in high school PURPOSE/HYPOTHESIS: Medical costs for sports, recreational, or exercise-
hockey players. related injuries continue to burden the medical system. Although evi-
CLINICAL RELEVANCE: Information from this study will assist individuals dence-based injury screening tools exist, they rarely address the multi-
designing training programs for hockey teams or designing sport spe- factorial nature of injury risk. A comprehensive injury screening system
cific return-to-play programs for individual players. Future research will that identifies those at highest risk of injury could be beneficial in miti-
determine if improvements in these off-ice variables directly transfer to gating injury risk with athletes, emergency response personnel, and the
improvements in on-ice skating. military. However, limited resources and time often prohibit such com-
prehensive screening. Solutions that leverage technology may be able to
SPO1107 improve the efficiency of this process. The purpose of this study was to
CONSERVATIVE TREATMENT FOR THE PREVENTION OF RECURRENT assess how automation can improve the efficiency of a comprehensive in-
LATERAL ANKLE SPRAINS IN ATHLETES: SYSTEMATIC REVIEW jury screening system.
WITH META-ANALYSIS NUMBER OF SUBJECTS: Healthy active duty service members (n = 247; M
Williams DW, Yanik MR, Sheets C, Allsopp BC, = 140, F = 107; age, 28.6  6.3 years; BMI, 25.1  2.7 kg/m2) were en-
Sabarre AR, Tate L rolled as part of a larger study at Fort Sam Houston. The data from 76 of
Physical Therapy, Duke University, Durham, NC these subjects were used to assess the efficiency of the screening process.
PURPOSE/HYPOTHESIS: Numerous papers and reviews address treatment MATERIALS/METHODS: Service members who were participating in mili-
of lateral ankle sprains in which the focus is on the rehabilitation of indi- tary and fitness training were recruited. Subjects completed a question-
vidual ankle impairments or primary prevention of lateral sprains. First- naire addressing demographics, job-specific activities, fitness level, cur-
time occurrence of ankle sprain is consistently identified as a risk factor rent and prior injuries, and biopsychosocial related factors associated
for future ankle sprain, yet limited information is known about the abil- with injury risk. Fourteen field expedient tests that measured functional
ity to prevent recurrent ankle sprains. This poster presents a systematic movement, dynamic balance, trunk stability, lower extremity power, mo-
review of randomized control trials examining the effect of physical ther- bility, and foot type were included. Netbook computers, handheld de-
apy intervention for the recurrence of lateral ankle sprains in athletes. vices, and a database server were used to automate the data collection
NUMBER OF SUBJECTS: One thousand four hundred sixty-one. process. The data collection process was reviewed following each trial
MATERIALS/METHODS: A sensitive search strategy was carried out using to identify ways to improve efficiency of the screening process. Subjects
PubMed and Science Direct, yielding 2069 articles (406 duplicates). were recruited in 12 groups; this analysis compares the first (day 1) and
The primary search string was (instability OR sprain OR laxity) AND second (day 2) data collection groups to discern the influence of automa-
(ankle) AND (recurrence OR prevention OR rehabilitation) AND (ath- tion; and the last data (day 12) collection group to compare the influence
letes). Two authors reviewed the articles for title, abstract, and full article of automation and process improvement. An ANOVA was used to deter-
review when appropriate. The majority of excluded articles did not spe- mine the time savings between the nonautomation, first automated, and
cifically address recurrence. Seven articles initially met the inclusion cri- the last automated trial.
teria; examination of references and citing articles yielded 2 additional RESULTS: There was a significant difference between day 1 (n = 22) with-
articles for a total of 9. Evaluation of the internal validity was rated using out automation to day 2 (n = 19) and day 12 (n = 35) with automation
the PEDro scale. Statistical analysis of odds ratios was performed using (P<.001). The average time to complete all of the stations was 84.5  9.1,
Cochrane RevMan software version 5.1. 66.8  6.1, and 47.1  5.2 minutes, respectively (P<.05). The average
RESULTS: Subjects ranged in age from 12 to 70; all were active in athletics, time saved for each of the 10 stations was 0.9  0.5 and 2.6  1.2 min-
and most were involved in team sports, particularly running and jump- utes between day 1 compared to days 2 and 12 (P<.05). The average time
ing (ie, soccer, basketball, volleyball). The range of PEDro scores (2-8 out saved for the surveys was 9.3  1.4 and 12.7  1.2 minutes between day
of 10) reflected the wide range of quality in the papers. All but 1 of the 1 and days 2 and 12 (P<.05).
individual trials demonstrated a significant effect of physical therapy in- CONCLUSIONS: Automation using handheld devices and netbook comput-
tervention. A comparison of all interventions to control group provided ers allowed for real-time data entry and enhanced the efficiency of an ev-
a statistically significant odds ratio of 0.39 (95% CI: 0.30, 0.51; P<.001). idence-based injury screening system that can be utilized to screen large
Both exercise versus control (OR, 0.44; 95% CI: 0.33, 0.60; P<.001) and groups of at-risk athletes, emergency personnel, and/or the military.
taping/bracing versus control (OR, 0.22; 95% CI: 0.13, 0.38; P<.001) CLINICAL RELEVANCE: Findings suggest that adding automated devices con-
also resulted in significantly decreased odds of recurrence. There was no tributed to a significant amount of time savings. Future research should
significant difference identified in trials that directly compared exercise identify and validate which of the field expedient tests best predicts in-
to taping/bracing (OR, 0.72; 95% CI: 0.29, 1.81; P = .49). jury risk.
CONCLUSIONS: The use of proprioceptive and strengthening exercise or
application of an external support reduces the odds of suffering a recur- SPO1109
rent ankle sprain when compared to a control. No difference in recur- THE IMPACT OF THIGH GIRTH ON THE RELIABILITY AND DIAGNOSTIC
rence rate was found comparing groups receiving external support and ACCURACY OF A LACHMAN TEST PERFORMED IN A PRONE POSITION
specific exercise. Mulligan EP, Harwell J, Robertson W
CLINICAL RELEVANCE: These findings, in a wide range of patient character- Department of Physical Therapy, University of Texas Southwestern
istics and interventions, support the use of physical therapy exercise and/ Medical Center School of Health Professions, Dallas, TX
or bracing modalities for prevention of recurrent ankle sprains. PURPOSE/HYPOTHESIS: This investigation was a prospective, blinded co-
hort study designed to evaluate the use of an alternate position to ex-
SPO1108 amine the integrity of the anterior cruciate ligament (ACL). Previous re-
ENHANCING EFFICIENCY THROUGH AUTOMATION FOR A COMPREHENSIVE search has suggested this technique is an effective method for clinicians
INJURY SCREENING SYSTEM with smaller hands to adequately stabilize the thigh of a larger individ-
Teyhen DS, Shaffer SW, Umlauf JA, Akerman RJ, Canada JB, ual; however, the efficacy of this method has not been established. The
Goffar SL, Walker MJ, Kiesel K, Plisky P, Butler RJ purpose of this study was to evaluate the reliability and diagnostic ac-
US Army-Baylor University Doctoral Program in Physical Therapy, Fort curacy of the Lachman test in a prone position and compare its abili-

ty to detect the presence of an ACL tear in subjects with small and large lateralis, medial gastrocnemius, tibialis anterior, medial and lateral ham-
thighs. strings, and gluteus medius and maximus) were recorded as each sub-
NUMBER OF SUBJECTS: Fifty-two consecutive subjects with a complaint ject ran at their preferred speed for 3 different step rate conditions: pre-
of knee pain were independently evaluated for the status of their ACL. ferred, +5% and +10%. Mean normalized EMG activities for each muscle
Study exclusion criteria included the inability to assume the prone test- during specific periods of the gait cycle (loading response, initial swing
ing position, evidence of a fracture, previous knee joint arthroplasty, sus- and late swing) were calculated and compared across step rate condi-
picion of posterior cruciate ligament involvement, or knee surgery in the tions using a 1-way ANOVA (P<.05).
previous 6 months. RESULTS: Increased activity of the gluteus maximus, medius, hamstrings,
MATERIALS/METHODS: The 52 subjects were examined by 2 physical thera- and gastrocnemius was evident during late swing when preferred step
pists in a prone position before any other diagnostic assessment. Direct rate was increased by 10%. A corresponding increase in activity of the
arthroscopic visualization and a consensus of clinical findings including rectus femoris and tibialis anterior was present during initial swing at
joint arthrometry and magnetic resonance imaging were used as the ref- the +10% step rate condition. However, none of the muscles showed a
erence standards. significant change during loading response (foot contact to peak knee
RESULTS: The study population consisted of 31 men and 21 women rang- flexion angle).
ing in age from 16 to 57. The acuity of their injury ranged from 21 to 365 CONCLUSIONS: Running with increased step rate is associated with an in-
days. Thigh size ranged from 34.0 cm to 59.1 cm in girth at a level 8 cm crease in muscle activity during initial and late swing phase in injury free
proximal to the mid-patella. Large thighs were defined as the 18 subjects subjects. The increased activity during late swing may be considered a
whose thigh girth was over 44 cm, which was at least twice the hand span preactivation in anticipation of foot-ground contact, which likely alters
of both examiners. Twenty-three of the 52 subjects had a torn ACL re- the landing posture of the limb and subsequently joint loading.
sulting in a prevalence of 44% for the entire study population. The ex- CLINICAL RELEVANCE: The reduced lower extremity loading that occurs
aminers agreed on their prone Lachman finding 90% of the time with when running with an increased step rate is accompanied by an increase
a kappa value of 0.81. For the 18 large thigh subjects there were 11 true in hip muscle preactivation. The increased activity observed in the glu-
negatives and 7 true positives with no false positives or negatives render- teus maximus and medius suggests that running with a greater step rate
ing perfect sensitivity and specificity in this subset of subjects. The ex- may have therapeutic benefits (ie, selectively recruit the muscles during
aminers also had perfect intratester agreement with kappa value of 1.0 late swing) to those with anterior knee pain considering these muscles
in the larger thigh population. The 18 smallest thighs in the study popu- are frequently targeted in rehabilitation programs.
lation were all under 40 cm in girth. For these subjects there were 3 false
negatives, 9 true negatives, 5 true positives, and 1 false positive rendering SPO1111
a sensitivity of 63% and specificity of 90%. In the 18 smaller thighs the CAN INJURY IN HIGH SCHOOL FOOTBALL BE PREDICTED BY A PRESEASON
examiners agreed on the status of the ACL 78% of the time with a kappa FUNCTIONAL MOVEMENT SCREEN?
coefficient value of 0.56. Rose J, Appling S, Bond A, Curry A, May B, Palazola C,
CONCLUSIONS: The prone Lachman test is an accurate and reliable evalu- Penner V, Vinson C
ation technique in subjects with large thighs that can be used to confirm Physical Therapy, University of Tennessee Health Science Center,
or reject the presence of an ACL tear. Memphis, TN
CLINICAL RELEVANCE: This study justifies the use of an alternative, noninva- PURPOSE/HYPOTHESIS: The objective of this study is to determine the re-
sive position of assessment to reliably identify the presence of excessive lationship between high school football players’ scores on a preseason
anterior tibial translation. The evaluation method is accurate in detect- Functional Movement Screen (FMS) and the likelihood of an in-sea-
ing the status of the ACL in subjects with large thighs that are difficult son injury. We hypothesized that players scoring below a determined
to manually stabilize. cut score will have an increased incidence of injury during the football
season.
SPO1110 NUMBER OF SUBJECTS: Subjects participating in this study (n = 77) were
CHANGES IN MUSCLE ACTIVATION PATTERNS WHEN RUNNING STEP members of a single high school football team. Inclusion criteria includ-
RATE IS INCREASED ed: male between the ages of 13 and 19; active member of the football
Chumanov ES, Heiderscheit B, Wille C team; passed a Preparticipation Physical Examination prior to FMS test-
Orthopedics and Rehabilitation, University of Wisconsin-Madison, ing. Subjects were excluded if FMS testing was contraindicated because
Madison, WI; Biomedical Engineering, University of Wisconsin-Madison, of a current injury.
Madison, WI MATERIALS/METHODS: IRB approval was obtained prior to data collec-
PURPOSE/HYPOTHESIS: Abnormal joint motion and loading are often con- tion. Subjects completed Grey Cook’s FMS testing. 7 components were
sidered contributing factors to running-related injuries. Changes to scored using an ordinal scale ranging from 0 to 3, with 3 being the high-
one’s running form, specifically running with an increased step rate or est (max score = 21). 2 licensed PTs and 10 student PTs, all trained in
decreased stride length, has been shown to reduce loading at the hip and FMS testing, served as examiners. Throughout the football season, the
knee, and therefore proposed as a potential strategy to reduce the risk of high school’s Athletic Trainer (ATC) collected relevant injury data. In-
injury. While it is clear that changing step rate can affect posturing and jury was defined as a traumatic or overuse event resulting from football
loading in the lower extremity, the associated changes in neuromuscu- that prevented participation in at least 1 game or practice. A compilation
lar activity have not been described. The purpose of this study was to ex- of the injury data was provided to the researchers. Nonparametric statis-
amine how neuromuscular activity changes with an increase in step rate tical analysis was used for this ordinal data. A Receiver Operator Curve
during running. Based on the known changes in joint kinematics and ki- (ROC) was performed to determine a cut point that maximized both sen-
netics, we hypothesized that running at a step rate greater than one’s pre- sitivity (true +s) and 1-specificity (false +s). Subjects were dichotomized
ferred rate would result in decreased muscle activities during the loading based on injury risk. The Mann-Whitney U (MWU) test assessed wheth-
response and increased activities during late swing phase. er there was a significant difference in FMS scores between those injured
NUMBER OF SUBJECTS: Forty-five injury-free, recreational runners (F = 20, and those who were not injured. The MWU compared the median of 2
M = 25; 32.7  15.5 years) took part in this study. groups with a significance level of α = .05. A 2-by-2 contingency table (α
MATERIALS/METHODS: Three-dimensional motion, ground reaction forc- = .05) was created using Excel software comparing true +s, true –s, false
es, and electromyography (EMG) of 8 muscles (rectus femoris, vastus +s and false –s.

RESULTS: Based on the ROC, a cut point of 13 on the FMS was posi- sive incident, it is of upmost importance to continue to monitor and safe-
tive to predict injury (sensitivity of 0.778; specificity of 0.441). We val- ly progress a patient through a proper progression to return to sport to
ued sensitivity (capturing true +s) over specificity (capturing true –s), to ensure safe return and reduce the chance for further or more severe in-
avoid losing any true +s. Scores 13 were determined to be at risk to sus- jury to the athlete.
tain an injury during the season; scores 14 scores were considered not
at risk to sustain an injury. Median FMS score for injured group: 14; me- SPO1113
dian FMS score for noninjured group: 13.76; the MWU test was nonsig- EPIDEMIOLOGY OF INJURIES IN THE ELITE FEMALE HIGH SCHOOL
nificant (P = .6475). There was no difference in FMS scores between the LACROSSE PLAYER
injured and noninjured groups. The contingency table was nonsignifi- Friel K, Hall CA, Dong M, Engel L, O’Boyle L, Pasquarella A,
cant, revealing 4 true +s, 33 true –s, 26 false +s, and 14 false –s. Serkes D, Smith K, Stoebe L, Valle D
CONCLUSIONS: Statistical analysis did not reveal a significant difference New York Institute of Technology, Old Westbury, NY
between the FMS scores of the injured group and the noninjured group. PURPOSE/HYPOTHESIS: High school (HS) lacrosse has grown in popularity
Unequal sample sizes between the injured and noninjured groups may in the last decade. Female lacrosse has grown 219% in that time period,
have biased the results; the relatively strict definition of injury may have making it the fastest growing sport in America. There are few resources
done the same. available describing the incidence and mechanism of injury for this pop-
CLINICAL RELEVANCE: The results of this study suggest the FMS may not be ulation. The purpose of this study was to investigate the epidemiology of
a good predictor of injury in male high school football athletes. elite female high school lacrosse injuries, and compare them to those in
the collegiate player. The results can help to increase the knowledge of,
SPO1112 and contributing factors to, lacrosse injuries and support further inves-
ABNORMAL RECOVERY OF A POSTCONCUSSED DIVISION I COLLEGIATE tigation for prevention.
FOOTBALL PLAYER NUMBER OF SUBJECTS: Five hundred.
Payette J, Mulligan I MATERIALS/METHODS: Surveys, consisting of 41 questions, were distribut-
Physical Therapy, Saint Francis University, Loretto, PA ed at practice sessions and tournaments in Delaware and New York to
BACKGROUND & PURPOSE: Most concussions resolve over a short period of 522 elite female high school lacrosse players. Twenty-two were exclud-
time as the patient is allowed to rest both physically and cognitively. Af- ed for incomplete information. Elite players were classified as playing
ter the patient’s subjective symptoms resolve, it is now common to return on 2 or more lacrosse teams in a year. Survey results were entered into
an athlete to play using a stepwise progression. For complex cases when SPSS Version 16.
symptoms persist, other means are required to ensure the patient’s safe RESULTS: Majority of surveyed athletes were HS freshmen and sopho-
return to sport. The purpose of this case study is to present the abnormal mores, coming from 10 states. 79% played for 2 lacrosse teams and 20%
recovery of a Division I football player from time of injury to his attempt played for 3 or more teams. Over 60% played other sports with soccer,
to return to sport over a 9-month period. basketball, and field hockey being the most common crossover sports.
CASE DESCRIPTION: The patient, a defensive lineman for a Division I uni- Fifty percent experienced a new injury while playing lacrosse and 16%
versity football team, suffered a concussion during a game in the 2010 had a recurrent injury from another sport, with more lacrosse injuries
season. The injury occurred after the patient made head-to-head contact occurring during in-season practice settings. The most common inju-
while attempting to tackle a player on the opposing team. There was no ries were to the ankle, knee and head, with LE injuries composed most-
apparent loss of consciousness at the time of injury. The patient came off ly of sprain/strain type injury. Eleven percent of respondents sustained a
the field under his own power and reported to the certified athletic train- concussion and of those, 35% had some degree of loss of consciousness.
er (ATC) that he had suffered a hit to the head. The patient reported that Although classified as a noncontact sport, 84% of injuries occurred via
he had neck pain immediately and that he felt “fuzzy and slowed down” contact with another player, ball or ground. Thirty-nine percent received
a few minutes after the injury. The patient was removed from the game physical therapy and 26% self-managed their injury at home. Forty-two
and assessed by the ATC for concussion. The patient did not return to the percent of athletes lost 10 or more days of playing time for their injury.
game that day. The patient was monitored by the ATC for 2 days follow- CONCLUSIONS: Overall injury rates are high for elite lacrosse which is clas-
ing the injury, before reporting to the rehabilitation facility for evalua- sified as a noncontact sport, and are comparable to those seen in the col-
tion. At the time of evaluation, the patient reported difficulty concentrat- legiate female lacrosse player during game-time situations. These elite
ing, sensitivity to light, dizziness, and fatigue. The evaluation included a HS players are exposed to more practice and game time than the tra-
battery of tests that have been well researched in the literature to assess ditional HS athlete, and perform at a higher level of intensity and skill.
for concussion. The test battery included: a clinical exam including dy- Participation on multiple teams as well as additional sports may be con-
namic gait index, Immediate Post-Concussion Assessment and Cognitive sidered contributing factors to their injury pattern.
Testing (ImPACT), Balance Error Scoring System (BESS), and Neuro- CLINICAL RELEVANCE: These results are concerning as these athletes, as
Com Sensory Organization Test. ImPACT and BESS tests were compared compared to the college player, have not yet reached skeletal maturity.
to baseline results obtained during preseason testing. The patient dem- This study can lead to the development of prevention programs targeted
onstrated deficits in all test areas and was referred to a neurosurgeon for to the specific injuries experienced during high school lacrosse. Empha-
further evaluation. The patient was to begin exertional testing after self- sis should be placed on more structured strength and conditioning pro-
reported symptoms had subsided, a satisfactory ImPACT test was com- grams than those normally seen for the female HS athlete.
pleted, and clearance from the neurosurgeon was obtained. During stage
1 exertional testing, the patient experienced a return in symptoms and SPO1114
test was terminated. At 3 months postinjury, the patient was still unable SURGICAL INTERVENTION, REHABILITATION, AND RETURN TO
to progress further than stage 1 exertional testing. PROFESSIONAL BASKETBALL FOLLOWING HIP ARTHROSCOPIC LABRAL
OUTCOMES: The patient did not play the remainder of the season and was RECONSTRUCTION AND MICROFRACTURE: A CASE REPORT
not cleared to participate in spring ball due to continued symptoms. Pa- Winninger L, Philippon M
tient was referred for further consultation with both a neurologist and Howard Head Sports Medicine Centers, Vail, CO; Steadman Philippon
neuropsychologist and continues to be monitored as he attempts to re- Research Institute, Vail, CO
turn to play. BACKGROUND & PURPOSE: Surgical treatment options and rehabilitation of
DISCUSSION: Despite a “typical” presentation of symptoms after a concus- intra-articular hip pathologies is rapidly expanding, including the tech-

niques for hip labral reconstruction and microfracture. Current litera- tion classes held twice per week for 5 weeks. During this program, three
ture is limited in regards to return to professional athletics following hip 1-legged hop tests, a single-legged hop for distance, a single-legged triple
arthroscopy to address deficient or advanced labral tears, femoral ace- hop for distance, and a single-legged triple crossover hop for distance,
tabular impingement (FAI), and chondral defects. The purpose of this were used to assess lower limb functionality. These hop tests were per-
case report is to describe the surgical intervention, rehabilitation, and formed on both the surgical leg and nonsurgical leg at the onset of the
outcomes of a professional basketball player’s return to play after under- Next Step Program (3 to 5 months postoperatively) and at the comple-
going revision hip arthroscopy. tion of the Next Step Program.
CASE DESCRIPTION: A 26-year-old male professional basketball player un- RESULTS: All 3 graft types showed significant improvement in mean func-
derwent revision arthroscopic hip surgery. He continued to have pain, tional test scores (distance in inches) from pre- to post-Next Step Pro-
limited ROM, and restrictions in athletic activities after initial surgery gram. Although patella tendon allograft patients showed the greatest
in 2003. His surgical procedure included hip labral reconstruction with mean improvement in functional test scores for all 3 hop tests, there
an IT Band autograft, acetabular microfracture, and a secondary osteo- was not a significant difference in overall improvement between the 3
plasty and rim trimming to address FAI. The patient was followed for graft types (P>.05). A significant effect of graft type was found for sin-
18 weeks and an individualized 4-phase rehabilitation program was uti- gle-legged hop distance at pre-Next Step (P = .035). Post hoc t tests re-
lized to direct the patient’s recovery. These 4 phases include Protection vealed that hamstrings autograft patients hopped significantly further
and Mobility, Stability, Strengthening, and Return to Sport, with specific than patellar tendon autograft patients (P = .039). A significant effect
criteria for advancement. Running and basketball progressions were im- of graft type was also found for single-legged triple hop distance at post-
plemented as appropriate. Objective measurements for ROM (goniom- Next Step (P = .045). Post hoc t tests revealed that hamstrings autograft
eter) and strength (handheld dynamometer) were obtained and a func- patients hopped significantly further than patellar tendon autograft pa-
tional sports test, used to determine dynamic neuromuscular control and tients (P = .042).
endurance of hip musculature, was administered and scored. Outcome CONCLUSIONS: Completion of a neuromuscular training program follow-
scores were tracked with the Lower Extremity Functional Scale (LEFS) ing ACL reconstruction leads to significant improvement in overall mean
and the Modified Harris Hip Score (MHH) during his rehab. functional test scores for all 3 graft types. Although differences were ob-
OUTCOMES: Patient returned to play at the professional level after 18 served between hamstrings autograft and patellar tendon autograft in in-
weeks of rehab. MHH hip score improved from 18 to 87 and his LEFS dividual hop tests, there is no clear statistical evidence that one graft type
score improved from 15 to 79. Patient concluded rehab with full ROM is superior in terms of overall functional improvement following a post-
and lower extremity strength compared to his nonoperative side. The ACL reconstruction neuromuscular rehabilitation program.
patient passed a functional sports test at 11 weeks, clearing him to par- CLINICAL RELEVANCE: All 3 ACL grafts produced statistically similar re-
ticipate in basketball-related strength and conditioning activities. Once sults in terms of postsurgical functional test improvement following a
returning, he gradually ramped up minutes played with minimal pain or 5-week advanced strength and neuromuscular rehabilitation program.
soreness in his hip after games. The patient subjectively reported doing Observed differences between graft types for individual hop tests may in-
well at 6 months and was averaging 35 to 40 minutes per game. dicate a need for graft-specific physical therapy protocols in the late stag-
DISCUSSION: The purpose of this case report was to demonstrate that an es of clinical rehabilitation to maximize lower extremity functionality fol-
athlete can return to the professional level following a revision hip ar- lowing ACL reconstruction.
throscopy, including labral reconstruction and microfracture. This re-
quires an individualized rehab program including range of motion, sta- SPO1116

bility and neuromuscular control, endurance-based strengthening, REHABILITATION AND RETURN TO SPORT FOLLOWING AN ISOLATED
functional exercises, and finally, a plan to progress and ramp up sports- MCL RUPTURE AND SURGICAL REPAIR IN AN ELITE ALPINE SKIER:
related activities. As the knowledge of intra-articular hip pathologies and A CASE REPORT
surgical techniques continue to advance, the rehabilitation following sur- Mymern M, Sterett W
gery must continue to develop in order to successfully return athletes to Physical Therapy, Howard Head Sports Medicine, Vail, CO;
play. Orthopaedics and Sports Medicine, The Steadman Clinic, Vail, CO
BACKGROUND & PURPOSE: This case report describes the examination, in-
SPO1115 tervention, and outcome of an elite alpine skier’s return to full compe-
THE EFFECTS OF GRAFT TYPE ON EARLY FUNCTIONAL RECOVERY OF ACL tition following an isolated distal medial collateral ligament avulsion.
RECONSTRUCTION PATIENTS FOLLOWING A SPECIFIC NEUROMUSCULAR/ Current literature is limited in the description regarding return to sport
AGILITY PROGRAM: A RETROSPECTIVE STUDY following a repair of an isolated MCL rupture with the utilization a func-
Asuma MA, Giveans M, Johnson M, Larson C tional return-to-sport test. This case can expand the efficacy of return-
Institute for Athletic Medicine, Fairview, Blaine, MN; Fairview Health to-sport progressions and the use of a functional sport test as a measure
Services, Minneapolis, MN; Minnesota Orthopedic Sports Medicine of a patient’s strength and neuromuscular control.
Institute, Eden Prairie, MN CASE DESCRIPTION: The athlete was a 20-year-old female alpine ski racer
PURPOSE/HYPOTHESIS: To determine if a specific ACL graft type produc- with a complete distal tear of her left medial collateral ligament (MCL).
es superior functional test results following a 5-week advanced, sports- Mechanism of injury: athlete was training alpine downhill in Portillo,
based rehabilitation program focusing on strength and neuromuscular Chile and sustained a high-velocity ski crash, resulting in an extreme
training. valgus stress. The athlete had a prior history of a left knee arthroscopy
NUMBER OF SUBJECTS: Eighty-three subjects with a status of post-ACL to address a lateral femoral condyle grade IV lesion in 2008. The athlete
reconstruction. had immediate pain and effusion of her left knee, instability and difficul-
MATERIALS/METHODS: Eighty-three patients who underwent ACL recon- ty with weight-bearing. MRI confirmed a MCL lesion. Intervention: Sur-
structive surgery were included in this retrospective study. All patients gical procedure; open MCL repair, followed by a 24-week, 4-phase grad-
had their reconstructive surgery done by 1 of 2 orthopaedic surgeons ed rehabilitation program culminating in a functional return-to-sport
with either hamstrings autograft (20 knees, mean age 18.0 years, 65% test. The rehabilitation program consisted of restoration of range of mo-
female), patella tendon autograft (42 knees, 18.8 years, 71%) or patella tion (ROM), swelling/edema reduction, closed kinetic chain strength,
tendon allograft (21 knees, 29.0 years, 52%). Each patient was enrolled dynamic lower extremity strength, alpine ski progression and function-
in our Next Step Program, which consisted of neuromuscular re-educa- al sport test.

OUTCOMES: Initial LEFS 8/80, Discharge LEFS 80/80. HHSMC Knee SPO1118
Sport Test 20/20. Athlete completed a return to alpine ski progression NONBATTLE KNEE-RELATED INJURIES AMONG US SERVICE MEMBERS
and return to full competition for University of Colorado Alpine Ski IN OPERATION IRAQI FREEDOM
Team, placing among the top 10 in the nation. Rauh MJ, Aralis HA, Macera CA, Bartlett JL, Boswell LL,
DISCUSSION: Intervention focused on restoration of range of motion Sessoms PH, MacGregor A, Han PP, Galarneau MR
(ROM), edema control, flexibility, proprioception, lower extremity Warfighter Performance, Naval Health Research Center, San Diego, CA;
strength, and neuromuscular endurance. With the increasing physical Medical Modeling, Simulation & Mission Support, Naval Health Research
demands on athletes, designing a comprehensive rehabilitation program Center, San Diego, CA
is integral part of the athlete performance. The athlete was required to PURPOSE/HYPOTHESIS: Although knee injuries have been reported among
pass a functional sport test in order to return to snow ski training. This the most common nonbattle injuries in military personnel serving in Op-
functional assessment tests the athletic endurance, dynamic strength, eration Iraqi Freedom (OIF), few studies have described their patterns
and anaerobic capacity and can fulfill simulated demands of numerous in detail. The purpose of this cross-sectional study was to determine the
sports. With continued use of sport-specific return-to-sport progression distribution of nonbattle knee-related injury among service members de-
we can gain valuable evidence in the most effective treatments when re- ployed in OIF.
turning athletes to competition. NUMBER OF SUBJECTS: We studied 418 US military personnel who sus-
tained a total of 464 nonbattle knee-related injuries (10.9%) of all non-
SPO1117 battle musculoskeletal injuries) while deployed in Iraq between May
THE RELATIONSHIP BETWEEN MEDIAL HEEL WHIP DURING RUNNING 2004 and January 2010.
AND LENGTH OF ILIOTIBIAL BAND AND RECTUS FEMORIS MATERIALS/METHODS: Data included knee injuries that resulted from non-
Silverman M, Maschi R, Hafer J battle activities while deployed in Iraq. An injury was defined as any ser-
Sports Medicine, Hospital for Special Surgery, New York, NY vice member complaint that required the attention of a military provider,
PURPOSE/HYPOTHESIS: Medial heel whip is a common gait deviation in regardless of the time lost from activity. We examined the knee injuries
runners. The cause of this deviation is not well understood. It has been by sex, activity during injury, method of injury, discharge disposition,
suggested that the unloading of tight proximal structures such as the and injury severity (Abbreviated Injury Score classification).
rectus femoris (RF) and the iliotibial band (ITB) during swing results RESULTS: Overall, 464 knee injuries were reported. By injury type, the
in this distal rotation. The RF and ITB would be excessively loaded with highest percentage reported were contusions/abrasions (24.4%), fol-
increased hip internal rotation during stance phase. Excessive hip inter- lowed by sprains (23.9%) and strains (19.8%), with similar proportions
nal rotation during stance phase has been associated with many running of these injuries incurred by male and female service members. The dis-
injuries such as ITBS and PFPS. It is the authors’ hypothesis that short- tribution of the 111 knee sprains were MCL (27.9%), ACL (16.2%), LCL
ened lateral and anterior structures (RF and ITB) that are loaded during (15.3%), PCL (3.6%) and nonspecific (36.9%). While contusions/abra-
stance phase in which there is excessive hip internal rotation may lead to sions (34.2%) were the most common injuries for nontraining activities,
tibial external rotation during subsequent swing phase. The purpose of the most common injuries during sports/recreation and training activ-
this preliminary study is to determine if there is a relationship between ities were sprains (32.2%) and strains (23.9%), respectively. Over half
short RF and ITB and the presence of a medial heel whip. (52.8%) of injuries were due to aggravated range of motion (repetitive
NUMBER OF SUBJECTS: Data were obtained from a retrospective chart re- motion or sudden movement) activities. Patellofemoral pain syndrome
view of 56 subjects (112 limbs) who presented to HSS Sports Rehab and (82.6%), strain (77.2%), tendonitis (77.1%), meniscal tears (66.7%), and
Performance Center for analysis of running gait mechanics. The re- sprain (55.9%) injuries were most often caused by aggravated range-of-
viewed chart includes anthropometric measurements and video clips of motion activities, while contusions/abrasions (74.3%) were due to mo-
subjects running on a treadmill. tor vehicle accidents. Overall, 83.9% of the knee injuries were classified
MATERIALS/METHODS: Thomas test knee flexion angle was recorded to as minor in severity, but a third (34.2%) of knee sprains were moder-
measure RF length. Ober’s test was performed in sidelying with knee ate in severity. While most (82.1%) service members returned to full or
flexed to measure ITB length. A positive test was recorded if the upper light duty after their knee injury, those who incurred a patellar fracture
limb failed to fall below horizontal. A negative test was recorded if the or meniscal tear (27.8%) or sprain (17.1%) were more likely to be trans-
upper limb dropped below horizontal. Medial heel rotation was mea- ferred or admitted to a medical treatment facility.
sured from posterior view video clips of subjects running on the tread- CONCLUSIONS: Contusions, sprains, and strains were the most common-
mill with use of Dartfish 2D motion analysis software. The maximal ly reported nonbattle knee injuries among service members deployed in
amount of rotation during swing was measured by bisecting the foot OIF. While most injuries were minor in nature, a higher percentage of
and recording the angle that the bisection makes with vertical. Two- patellar fractures, sprains, and meniscal tears required advanced medi-
tailed bivariate Pearson correlations were calculated between medial cal services.
heel whip and Thomas and Ober test values. Significance was set at CLINICAL RELEVANCE: In terms of injury prevention planning, studies are
P<.05. needed to determine the most common aggravated range-of-motion ac-
RESULTS: Mean values for medial heel whip and Thomas Test were 13.9° tivities responsible for causing knee injuries. Since knee sprains may in-
 8.1° and 54.8°  12.1°, respectively. Fifty-five limbs had a positive Ober volve increased medical costs and time lost from duty, studies are need-
test. Medial heel rotation was negatively correlated with Thomas Test ed to identify the incidence and common risk factors of these injuries in
(r = –0.36, P = .00) and positively correlated with Ober test (r = 0.32, military members serving in OIF to reduce their injury risk.
P = .00).
CONCLUSIONS: There appears to be a relationship between medial heel SPO1119
whip in runners and length of RF and ITB. Runners demonstrating a FOOT CONTACT PATTERNS AND JOINT DEMANDS IN NOVICE BAREFOOT
larger medial heel whip had greater limitations of ITB and RF length. RUNNERS BEFORE AND AFTER EXERTION
Further research is necessary to determine if there is a causative effect. Hashish R, Samarawickrame S, Powers C, Salem G
CLINICAL RELEVANCE: While performing observational or video gait anal- Biokinesiology and Physical Therapy, University of Southern California,
ysis of runners, presence of a medial heel whip may warrant closer ex- Los Angeles, CA
amination of RF and ITB length. This deviation may predict inadequate PURPOSE/HYPOTHESIS: Reports of a lower prevalence of injuries in habitual
length of ITB and RF. barefoot (BF) runners have encouraged research to assess the influence

of this running style on injury potential. BF running is promoted based climb in an indoor climbing facility, and 63% had a rock climbing–re-
on its forefoot contact pattern and the associated reduction of the verti- lated injury (44.6% hand/elbow injury, 37.2% finger injuries). Only 10%
cal ground reaction force (vGRF) impact transient. However, the effect of survey respondents accessed physical therapy for injury management.
of exertion on BF running foot contact (FC) patterns has not been exam- The majority of rock climbers (67%) used the internet for injury preven-
ined. For example, novice BF runners may fatigue more readily than ex- tion and treatment. In the rock climbing community no consensus has
perienced BF runners, and thus alter foot/surface contact patterns and been reached on the best preventive methods to reduce rock climbing
joint demands in a way that could put themselves at increased risk of in- injuries (finger strengthening, general conditioning, taping, rest, mas-
jury. The purpose of this study was to (1) quantify the changes in ankle sage, or stretching).
kinematics at FC, and (2) to characterize the biomechanical demand at CONCLUSIONS: The survey respondents demonstrated minimal knowledge
the ankle, knee, and hip in novice BF runners, before and after exertion. regarding injury prevention and treatment. Rock climbers use sources
NUMBER OF SUBJECTS: Three. other than physical therapists to treat and prevent the most common
MATERIALS/METHODS: Three habitually shod distance runners performed climbing injuries.
overground BF running at their self-selected speed, before and after ex- CLINICAL RELEVANCE: The increase in climbing injuries presents an oppor-
ertion. All subjects included in the study ran a minimum of 12 kilometers tunity for physical therapists, with expertise in movement science and in-
(km) per week, and reported no significant injuries over the preceding 12 jury prevention, to address the unique injuries sustained by rock climb-
months. The exertion protocol was a BF run of 1.6 km at their self-select- ers. Further research is needed to examine specific rock climbing injuries
ed speed. Kinematics were recorded using a Qualisys motion capture sys- (injury pattern, prevention, and intervention).
tem (Gothenburg, Sweden) at 250 Hz. Three-dimensional kinetics were

recorded from AMTI force platforms (Watertown, MA) at 1500 Hz. FC SPO1121
was defined as a minimum of 20 Newtons vGRF. The support moment FIELD TESTING DYNAMIC BALANCE IN RWANDA
was calculated as the sum of the sagittal plane extensor moments during Butler RJ, Queen R, Kiesel K, Plisky P
the absorption (first half of the stance) phase of running. Mean absolute Community Health and Family Medicine, Doctor Division of Physical
differences, or relative contributions, and the associated effect sizes (ES; Therapy, Duke University, Durham, NC; Physical Therapy, University
Cohen’s d) between the 2 conditions are reported. of Evansville, Evansville, IN
RESULTS: Following the exertion protocol, the ankle position changed PURPOSE/HYPOTHESIS: Dynamic balance is an important component of
from a position of plantar flexion (–10.27°) to dorsiflexion (3.38°; ES motor skill development. Poor dynamic balance has previously been as-
2.32), suggesting a heel strike FC. The relative contribution of the ankle sociated with sport-related injury. However, the vast majority of dynam-
and hip was observed to decrease appreciably (43.4% to 36.9%; ES: 1.14 ic balance studies as they relate to sport injury have occurred in devel-
and 11.0% to 8.7%; ES: 0.35, respectively), while the demand at the knee oped North American or European countries. The purpose of this study
increased (45.8% to 54.4%; ES: 1.13). was to compare dynamic balance in teenage male soccer players from
CONCLUSIONS: The findings from this preliminary investigation suggest Rwanda and compare their performance to a matched group from the
that exertion changes BF running mechanics in a way that negates any United States.
potential benefits associated with this running style. In particular, sub- NUMBER OF SUBJECTS: Twenty-six teenage male soccer players from Rwan-
jects reverted to a heel strike FC pattern and exhibited an increase in the da and 26 age- and gender-matched control subjects from the United
biomechanical demand at the knee following exertion. States.
CLINICAL RELEVANCE: The findings suggest that training programs designed MATERIALS/METHODS: All athletes were screened on the Y-Balance Test
to transition runners from shod to BF should consider the effects of exer- during their preparticipation physical. Any athlete who exhibited pain
tion on running mechanics. during activities of daily living was excluded from testing. Performance
on the test was examined for the anterior, posteromedial, and postero-
SPO1120 lateral reach directions bilaterally. Reach symmetry (cm) between limbs
CLIMBING INJURIES IN ROCK CLIMBERS was examined for all reach directions. In addition, reach distance in each
Lee RT, Sweeney JK, Reicherter EA direction (normalized to percent limb length, %LL) and the composite
Transitional Doctor of Physical Therapy, Rocky Mountain University reach score (%LL) were examined. Dependent samples t tests were per-
of the Health Profession, Provo, UT; Physical Therapy and Rehabilitation formed with significant differences identified at P<.05.
Science, University of Maryland-Baltimore School of Medicine, RESULTS: Twenty-six male soccer players from Rwanda (R: 16.5  1.2
Baltimore, MD years old; 92.0  4.2 cm LL) were matched to 26 male soccer players
PURPOSE/HYPOTHESIS: The number of people participating in rock climb- from the United States (US: 16.0  0.9 years old; 92.1  4.1 cm LL).
ing has increased exponentially as indoor rock climbing facilities have The Rwandan soccer players performed better in the anterior (R: 83.9
become readily available in the United States. The increased accessibility  3.2 %LL; US: 76.5  6.6 %LL; P<.01), posterolateral (R: 114.4  8.3
to rock climbing has led to an increase in injuries that are unique to the %LL; US: 106.5  8.2 %LL; P<.01), and composite (R: 105.6  1.3 %LL;
sport of climbing. The goals of this survey were to (1) identify the most US: 97.8  6.2 %LL; P<.01) reach scores. No differences were appar-
common injuries sustained by adults participating in rock climbing, (2) ent for the posteromedial reach direction or any of the symmetry mea-
determine where the athletes obtain information regarding injury pre- sures (P>.05).
vention and treatment, (3) inform physical therapists about the frequen- CONCLUSIONS: Teenage soccer players from Rwanda exhibit better dynam-
cy of climbing injuries, and (4) highlight research needs for the treat- ic balance in comparison with similar athletes from the United States.
ment and prevention of injuries sustained during rock climbing. Interestingly, measures of symmetry in dynamic balance were similar be-
NUMBER OF SUBJECTS: One hundred eight survey respondents. tween groups. It will be interesting to examine how these dynamic bal-
MATERIALS/METHODS: A 13-question survey was sent to healthy adult (20- ance abilities correlate with injury rates in Rwanda.
40 years of age) members of a climbing gym in Davis, CA who regularly CLINICAL RELEVANCE: The examination of movement abilities in other cul-
access an indoor rock climbing facility for training and exercise. Partici- tures allows for an understanding of how fundamental movement pat-
pants described injury history, most feared climbing injury, current in- terns may be affected by cultural differences. Examining crosscultural
jury prevention and treatment knowledge, and frequency of accessing performance on standardized movement tests may aid our understand-
physical therapy to treat injuries. ing of optimal human movement. This understanding may facilitate the
RESULTS: Sixty-one percent of the athletes climb 3 to 4 days/week, 91% development of global movement function standards.

SPO1122 trials of the single leg hop for distance and the Y-balance test were per-
IMPACT OF LOWER EXTREMITY MUSCLE FATIGUE ON PERFORMANCE formed on the left (L) and right (R) lower extremity, measured in centi-
OF THE STAR EXCURSION BALANCE TEST IN HEALTHY VOLUNTEERS meters. All test measures were normalized to height. PASW Statistics 18
Manske RC, Smith B, Borchers T, Bruey C, Crotts C, Gile K was used to analyze descriptives, and Pearson correlations were used to
Physical Therapy, Wichita State University, Wichita, KS determine the relationship between the components and overall score of
PURPOSE/HYPOTHESIS: To examine the effects of lower extremity muscle the Y-balance test and the hop test.
fatigue in regard to performance on the Star Excursion Balance Test RESULTS: The normalized male scores for the Y-balance test are (left/
(SEBT). The hypothesis is that SEBT performance will be altered follow- right; mean [SD]): anterior = 0.460 (0.078)/0.457 (0.076); PM = 0.576
ing fatigued conditions. (0.071)/0.575 (0.072); PL = 0.548 (0.072)/0.546 (0.066); total = 1.58
NUMBER OF SUBJECTS: Thirty-two healthy college-age students (aged 18- (0.179)/1.58 (0.177). The normalized female scores for the Y-balance test
30) with no history of lower extremity injury served as their own con- are: anterior = 0.429 (0.076)/0.433 (0.083); PM = 0.542 (0.087)/0.539
trols for all testing. (0.081); PL = 0.518 (0.081)/0.512 (0.084); total = 1.49 (0.217)/1.48
MATERIALS/METHODS: The SEBT required participants to reach with the (0.216). The normalized hop test scores for males (left/right) were 1.05
lower extremity in 8 directions 3 times. The SEBT is a multidirection- (0.133)/1.05 (0.132); females, 0.815 (0.176)/0.822 (0.174). The hop test
al test of dynamic postural control that involves balancing on 1 leg and showed a significant correlation with each component of the Y-balance
reaching maximally with the other leg in 8 directions. Prior to experi- test as well as the total score for both left and right (P<.01). The an-
mental sessions, a baseline measurement of the SEBT was taken. The terior component showed a small correlation (left, r = 0.340; right, r
average of the 3 reaches was recorded as distance reached. An isokinetic = 0.326); the posterolateral and posteromedial components, and total
dynamometer fatigued knee extensors, hip abductors, and hip extensors. score showed a moderate correlation (r = 0.472-0.555).
Each was fatigued in 3 separate experimental sessions all 1 week apart CONCLUSIONS: Increased distance on the single leg hop for distance is as-
allowing for adequate recovery time. Muscle fatigue was reached when sociated with increased excursion on each component of the Y-balance
the isokinetic force output for each muscle group fell below 50% of max- test, as well with an increased total score on the Y-balance test in colle-
imum torque output. Once this level was reached, the participants com- giate athletes.
pleted the SEBT. Statistical results based on repeated-measures ANOVA CLINICAL RELEVANCE: An algorithm using valid, easily administered clini-
were analyzed to determine the effects of fatigue on performance. cal tests needs to be established to assist return-to-play decision making
RESULTS: Mean reach distances were found to be less than baseline val- after ankle rehabilitation, including a component that assesses tolerance
ues in all of the directions following fatigue of each muscle group test- to impact. These results are a step toward developing a more criterion-
ed. Significant differences for anterolateral, posterior, posteromedial, based system of tests to determine return to play following ankle injury.
and medial reach were found after fatigue of knee extensors. Lateral and
posterolateral reach were the only directions that were not significantly SPO1124
decreased following fatigue of the hip abductors, and the hip extensors. COMPARISON OF DOMINANT AND NONDOMINANT ELBOW PASSIVE RANGE
CONCLUSIONS: Fatigue of knee extensors, hip abductors, and hip extensors OF MOTION IN PROFESSIONAL BASEBALL PITCHERS
significantly affected performance on the SEBT as a whole. All postfa- Duncan SL, Wilk KE, Macrina LC, Fleisig GS
tigue measurements were significantly less than baseline. Rosalind Franklin University of Medicine & Science, North Chicago, IL;
CLINICAL RELEVANCE: In a young, healthy population, exercises that may Champion Sports Medicine, Birmingham, AL; American Sports Medicine
lead to fatigue of these muscles should be done after the SEBT (as a mea- Institute, Birmingham, AL
sure of balance) is performed to minimize the effect of fatigue on scores PURPOSE/HYPOTHESIS: During the pitching motion, tremendous force and
for this test. Testing should be done prior to excessive lower extremi- torque are generated at the elbow joint, placing significant stress on the
ty fatigue. ulnar collateral ligament and bony articulation. It has been suggested
that repetitive stress from pitching may lead to side-to-side differences
SPO1123 in elbow passive range of motion (PROM). The purpose of this study was
RELATIONSHIP BETWEEN THE STAR EXCURSION BALANCE TEST AND to compare dominant and nondominant elbow flexion, extension, total
SINGLE LEG HOP FOR DISTANCE IN VARSITY COLLEGIATE ATHLETES range of motion (flexion + extension), supination, and pronation in pro-
Pontillo M, Forsythe S fessional baseball pitchers.
GSPP Penn Therapy and Fitness at Penn Sports Medicine Center, NUMBER OF SUBJECTS: A total of 231 professional major and minor league
Philadelphia, PA baseball pitchers from 1 organization were tested during a 4-year period
PURPOSE/HYPOTHESIS: There is a lack of tests that assess the ability of the (2008-2011). This included 169 individual athletes.
ankle joint to tolerate impact following injury. The Star Excursion Bal- MATERIALS/METHODS: During spring training physical examinations,
ance Test (SEBT), specifically the 3 components of the Y-balance test PROM of the dominant and nondominant elbows (flexion, extension,
(anterior = A, posteromedial = PM, posterolateral = PL), has been corre- supination, and pronation) was measured using a standard goniometer.
lated with ankle instability and incidence of ankle injury but does not in- An examiner brought the joint through full PROM until an end feel was
corporate the plyometric activity required of many sports. The single leg established. Paired-samples t tests (P<.05) were used to determine if a
hop for distance test is well established for testing knee function, impos- significant difference exists between dominant and nondominant elbow
es plyometric demands upon the lower extremity, and may be extended range of motion.
to determine return-to-play readiness in the ankle. The purpose of this RESULTS: Dominant elbow flexion (146.0°  6.4°) was significantly less
study was to evaluate if a relationship exists between performance on the than nondominant elbow flexion (149.0°  6.1°). There was also a signif-
Y-balance test and the single leg hop for distance. icant difference in elbow extension; on average, the dominant elbow had
NUMBER OF SUBJECTS: Two hundred twelve healthy varsity collegiate ath- slight flexion (2.2°  9.8°) whereas the nondominant elbow had slight
letes (M = 123, F = 89; mean age, 18.1 years; range, 17-22). Subjects who hyperextension (–2.7°  8.0°). Additionally, dominant total PROM
were unable to perform any component of either test due to current in- (143.8°  13.5°) was significantly less than nondominant total PROM
jury were excluded. (151.2°  11.9°). There were no significant side-to-side differences in pro-
MATERIALS/METHODS: Each subject was assessed by 1 of 2 physical thera- nation (dominant, 87.4°  8.1°; nondominant, 87.8°  7.5°) or supina-
pists during preparticipation physicals. Demographic data including age, tion (dominant, 93.4°  10.8°; nondominant, 94.4°  11.1°).
height, weight, sport, position, and injury history were collected. Two CONCLUSIONS: Professional baseball pitchers exhibit significantly less el-

bow flexion, extension, and total PROM in the dominant arm. There MATERIALS/METHODS: Prior to testing, each athlete completed a preseason
were no differences between dominant and nondominant supination or questionnaire regarding demographic and preseason training behaviors.
pronation. The athletes performed the SLJ 3 times and their mean distance jumped
CLINICAL RELEVANCE: These results suggest that professional pitchers com- was used in study analyses after jump distance scores were normalized to
monly exhibit a loss of elbow PROM in the dominant arm. It is impor- athlete’s height. ANOVA was performed to assess whether jump distance
tant for physical therapists to recognize the typical side-to-side differ- scores differed by preseason training and anthropometric measures. Lo-
ences in elbow PROM values when designing rehabilitation programs gistic regression was used to examine if an association between distanced
for professional pitchers following surgery or injury. jumped (normalized to height) and increased likelihood of injury existed.
Cut scores for SLJ distances (male athletes at least 90% of one’s height;
SPO1125 female athletes at least 80% of one’s height) were based on previously re-
UTILITY OF THE STANDING LONG JUMP TEST AS A PRESEASON ported clinical recommendations.
SCREENING TOOL FOR INJURY RISK IN DIVISION III COLLEGIATE ATHLETES RESULTS: Male athletes jumped significantly farther (1.69  .20 m) than
Brumitt J, Rauh MJ, Heiderscheit B, Manske RC, Niemuth PE their female counterparts (1.31  .17 m) (P<.0001). Males who report-
School of Physical Therapy, Pacific University, Hillsboro, OR; Graduate ed weight-lifting greater than 5 hours a week jumped significantly far-
Program in Orthopaedic and Sports Science, Rocky Mountain University ther than males who weight-lifted 3 hours or less (P = .05). Females who
of Health Professions, Provo, UT; Department of Orthopedics and Reha- participated in weight-lifting 3 to 5 h/wk and plyometric exercises 1 to
bilitation, University of Wisconsin-Madison, Madison, WI; Department 3 h/wk during the preseason jumped significantly farther (P = .04) than
of Physical Therapy, Wichita State University, Wichita, KS; Department females who participated only 0 to 1 h/wk. Forty-six athletes (F = 27, M
of Physical Therapy, St Catherine University, Minneapolis, MN = 19) sustained a total of 63 back or lower extremity injuries during the
PURPOSE/HYPOTHESIS: The Standing Long Jump (SLJ) test has been pri- study. Although males who jumped less than 90% of their height were
marily used as a return-to-sport test. The purpose of this prospective co- twice as likely to incur an injury (odds ratio [OR], 2.0; 95% CI: 0.7, 6.4;
hort study was to determine if the SLJ test could be used as a preseason P = .22) than males who jumped 90% or more of their height, the find-
screening tool to predict time-loss sports-related low back or lower ex- ing was not significant. The likelihood of incurring an injury for females
tremity injury among collegiate athletes. We expected that athletes with who jumped less than 80% of their height was similar (OR, 0.9; 95%
shorter jump distances would be at greater risk for injury. A secondary CI: 0.4, 2.1; P = .73) to females who jumped at least 80% of their height.
purpose of this study was to examine relationships between SLJ and pre- CONCLUSIONS: As a preseason functional test, the SLJ did not appear to be
season training activities in a collegiate athletic population. useful in identifying athletes at an increased risk for injury for male or fe-
NUMBER OF SUBJECTS: We tested 193 Division III athletes (110 females; male athletes participating in DIII collegiate sports.
age, 19.1  1.1 years; 83 males; age, 19.5  1.3 years) prior to the start CLINICAL RELEVANCE: While the findings between SLJ and preseason train-
of their sports seasons. The athletes were then prospectively followed ing activities may be useful for strength coaches when designing their
during their sports season for occurrence of low back or lower extrem- athletes’ preseason training programs, the results from this study sug-
ity injury. gest that its use as a tool to predict injury in collegiate athletes is limited.

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Combined Sections Meeting

Sports Physical Therapy Section

of the authors. In the identification number above each abstract,

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Swimming sanctioned events, and up to 91% of competitive swimmers Florida.

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quires an individualized rehab program including range of motion, sta- SPO1116

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tem (Gothenburg, Sweden) at 250 Hz. Three-dimensional kinetics were

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